2023-2024 Dependency Override Request Form

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Submit a typed letter of explanation detailing the special circumstances that make you independent from both parents. Address the following in your explanation:
  • The nature of your relationship with both of your parents
  • Provide the date and place of your last contact with both parents
  • How you have been supporting yourself
Submit letters from at least two individuals who can attest to your situation. The letter should be one to two pages in length and provide as much detail as possible describing your separation from both parents:
  • The letter should be from an individual not related to the student (i.e. counselor, social worker, teacher, clergy, police, landlord, etc.). Please submit on professional letterhead.
  • The letter must include the individual's name, title or position, address, phone number, and must be signed.
    The individual must reside at a separate address from the student.
Submit a signed copy of your 2021 federal tax return. If you did not file a 2021 tax return, please provide a list of income earned for 2021 and W-2 form(s) or other earning statements if available. You can request a transcript from the IRS online at https://www.irs.gov/individuals/get-transcript.

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At home with parents Other

At home with parents Other

Yes No
2022 Student Income Resources
Monthly Amount
Income from work
$
Unemployment Compensation
$
Social Security Benefits
$
Housing Assistance
$
Food Stamps
$
Other Income (monetary gifts)
$
Total
$

WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both.

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